Appendix K

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In appendix K:
Key Ideas Underlying Motivational Interviewing
Goal of Motivational interviewing
Principles of Motivational Interviewing

Key Ideas Underlying Motivational Interviewing

Counsellors’ style is a powerful determinant of client resistance and change; Argumentation tends to evoke resistance.
When resistance is evoked, clients tend not to change and resistance may include arguing, changing the subject, interrupting, denying the problem.
Client motivation can be increased by a variety of counsellor strategies.
Motivation emerges from the interpersonal interaction between the client and the counsellor.
Ambivalence – feeling in two minds about something – is normal.
Assisting people to resolve ambivalence is a key to change.

Goal of Motivational interviewing

Elicit from the client their reasons for concern, plus their arguments for change.

Note; the goal is not to change the client’s behaviour but to allow the client to argue for their own change.

Motivational interviewing is a style of counselling particularly suitable for clients who are feeling ambivalent about changing their behaviour. The counsellor practicing motivational interviewing utilises Rogerian non-directive strategies - in a particular way and for a particular purpose - to encourage the client to explore their ambivalence and consider the possibility for change. In pursuing this goal, the counsellor will have a strong sense of purpose and may sometimes be directive and incisive.

Motivational interviewing prepares people for change. When successful, the client will be ready to actually change their behaviour, at which point a range of other approaches will be useful. It is particularly appropriate when the client is at the precontemplation or contemplation stages but can be used whenever someone is feeling ambivalent.

Principles of Motivational Interviewing

Motivational interviewing rests on five basic principles:

Express Empathy

Unconditional acceptance of the client’s position;
Skilful reflective listening;
View ambivalence and client’s perspective as normal and understandable;
Do not label client’s behaviour.

Deploy Discrepancy

Create and amplify the discrepancy between client’s current behaviour and their goals;
Clarify important goals and explore the consequences of client’s present behaviour that conflict with those goals;
Assist the client to argue for their own change.

Avoid Argumentation

Arguments are counterproductive;
Defending breeds defensiveness;
Client resistance is a signal to change strategies

Roll with Resistance

Don’t push against the client’s views
Clients statements can be reframed to create a new momentum for change

In summary …

Express empathy by accurate listening that clarifies the client’s experience, feelings and interpretations
Amplify discrepancy between current behaviour and broader goal by weighing pros and cons
Arguments are counterproductive and breed resistance
When faced with resistance, review clients readiness to change
Support belief in the possibility of change. The client is responsible for choosing and carrying out change.

(Miller and Rollnick, 1991. Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York, NY:Guilford)